Wednesday, September 05, 2007

Pain Management: A Fundamental Human Right

Frank Brennan, Daniel B. Carr, and Michael Cousins

Abstract

This article surveys worldwide medical, ethical, and legal trendsand initiatives related to the concept of pain management asa human right. This concept recently gained momentum with the2004 European Federation of International Association for theStudy of Pain (IASP) Chapters-, International Association forthe Study of Pain- and World Health Organization-sponsored "GlobalDay Against Pain," where it was adopted as a central theme.We survey the scope of the problem of unrelieved pain in threeareas, acute pain, chronic noncancer pain, and cancer pain,and outline the adverse physical and psychological effects andsocial and economic costs of untreated pain. Reasons for deficienciesin pain management include cultural, societal, religious, andpolitical attitudes, including acceptance of torture. The biomedicalmodel of disease, focused on pathophysiology rather than qualityof life, reinforces entrenched attitudes that marginalize painmanagement as a priority. Strategies currently applied for improvementinclude framing pain management as an ethical issue; promotingpain management as a legal right, providing constitutional guaranteesand statutory regulations that span negligence law, criminallaw, and elder abuse; defining pain management as a fundamentalhuman right, categorizing failure to provide pain managementas professional misconduct, and issuing guidelines and standardsof practice by professional bodies. The role of the World HealthOrganization is discussed, particularly with respect to opioidavailability for pain management. We conclude that, becausepain management is the subject of many initiatives within thedisciplines of medicine, ethics and law, we are at an "inflectionpoint" in which unreasonable failure to treat pain is viewedworldwide as poor medicine, unethical practice, and an abrogationof a fundamental human right.